Authority for Authorised Persons to sign claim forms on behalf of a hospital authority form (PB142)

Use this form to authorise a person to sign forms on behalf of a hospital authority to supply pharmaceutical benefits or highly specialised drugs.

You can also use this form to authorise a pharmacist to sign pharmaceutical benefit claim forms and endorse pharmaceutical benefit prescriptions on behalf of a hospital authority or request removal of previously authorised pharmacist.

 
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

Page last updated: 27 August 2017